Advertisement

Diagnosis and Treatment of Acquired Immune Deficiency States and Opportunistic Infections

  • Steve B. Kalish
  • David G. Ostrow
  • John P. Phair

Abstract

The majority of conditions presented in this monograph are concerned with the management of infections occurring in presumably immunocompetent or normal hosts. Recently, an acquired immunodeficiency syndrome (AIDS) associated with opportunistic infections (OIs), Kaposi’s sarcoma (KS), and lymphoproliferative malignancies has been described in homosexually active men.1–8 In this chapter the clinical and immunologic evaluation of patients with AIDS and the diagnosis and management of infections caused by opportunistic pathogens are discussed. Further, the current status of attempts to modulate the immune response and an approach to counseling individuals at risk are presented.

Keywords

Herpes Simplex Herpes Zoster Pneumocystis Carinii Pneumonia Cryptococcal Meningitis Sexually Transmitted Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gottlieb MS, Schroff R, Schanker HM, et al: Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: Evidence of a new acquired cellular immunodeficiency. N Engl J Med 305: 1425–1431, 1981.PubMedCrossRefGoogle Scholar
  2. 2.
    Masur H, Michelis MA, Greene JB, et al: An outbreak of community-acquired Pneumocystis carinii pneumonia: Initial manifestation of cellular immune dysfunction. N Engl J Med 305: 1431–1438, 1981.PubMedCrossRefGoogle Scholar
  3. 3.
    Siegal FP, Lopez C, Hammer GS, et al: Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Engl J Med 305: 1439–1444, 1981.PubMedCrossRefGoogle Scholar
  4. 4.
    Hymes KB, Greene JB, Marcus A, et al: Kaposi’s sarcoma in homosexual men-A report of eight cases. Lancet 2: 598–600, 1981.PubMedCrossRefGoogle Scholar
  5. 5.
    Friedman-Kien AE, Laubenstein LJ, Rubinstein P, et al: Disseminated Kaposi’s sarcoma in homosexual men. Ann Intern Med 96: 693–700, 1982.PubMedGoogle Scholar
  6. 6.
    Mildvan D, Mathur U, Enlow RW, et al: Opportunistic infections and immune deficiency in homosexual men. Ann Intern Med 96: 700–704, 1982.PubMedGoogle Scholar
  7. 7.
    Follansbee SE, Busch DF, Wofsy CB, et al: An outbreak of Pneumocystis carinii pneumonia in homosexual men. Ann Intern Med 96: 705–713, 1982.PubMedGoogle Scholar
  8. 8.
    Gerstoft J, Malchow-Moller A, Bygbjerg I, et al: Severe acquired immunodeficiency in European homosexual men. Br Med J 285: 17–19, 1982.CrossRefGoogle Scholar
  9. 9.
    Durack DT: Opportunistic infections and Kaposi’s sarcoma in homosexual men. N Engl J Med 305: 1465–1467, 1982.CrossRefGoogle Scholar
  10. 10.
    Fauci AS: The syndrome of Kaposi’s sarcoma and opportunistic infections: An epidemiologically restricted disorder of immunoregulation. Ann Intern Med 96: 777–779, 1982.PubMedGoogle Scholar
  11. 11.
    Haynes BF, Katz P, Fauci AS: Immune responses of human lymphocytes in vitro, in Schwartz RA (ed): Progress in Clinical Immunology. New York, Grune & Stratton, 1980, pp 23–106.Google Scholar
  12. 12.
    Reinherz EL, Kung PC, Goldstein G, et al: Separation of functional subsets of human T cells by a monoclonal antibody. Proc Natl Acad Sci USA 76: 4061–4065, 1979.PubMedCrossRefGoogle Scholar
  13. 13.
    Notkins AL, Mergenhagen SE, Howard RJ: Effect of virus infections on the function of the immune system. Annu Rev Microbiol 24: 525–528, 1976.CrossRefGoogle Scholar
  14. 14.
    Fauci AS, Haynes BF, Katz P: Drug-induced T and B lymphocyte and monocyte dysfunction, in Grieco MH (ed): Infections in the Abnormal Host. New York, Yorke Medical Books, 1980, pp 163–182.Google Scholar
  15. 15.
    Armstrong D: Infections in patients with neoplastic disease, in Verhoef J, Peterson PK, Quie PG (eds): Infections in the Immunocompromised Host-Pathogenesis, Prevention and Therapy. New York, Elsevier/North-Holland, 1980, pp 129–158.Google Scholar
  16. 16.
    Armstrong D: Fungal infections in the compromised host, in Rubin RH, Young LS (eds): Clinical Approach to Infection in the Compromised Host. New York, Plenum Medical, 1981, pp 195–228.Google Scholar
  17. 17.
    Sheft DJ, Shrago G: Esophageal moniliasis: The spectrum of disease. JAMA 213: 1859–1862, 1970.PubMedCrossRefGoogle Scholar
  18. 18.
    Shortsleeve MJ, Gauvin GP, Gardner RC, et al: Herpetic esophagitis. Radiology 141: 611–617, 1981.PubMedGoogle Scholar
  19. 19.
    Stone HH, Kolb LD, Currie CA, et al: Candida sepsis: Pathogenesis and principles of treatment. Ann Surg 179: 697–711, 1974.PubMedCrossRefGoogle Scholar
  20. 20.
    Eng RHK, Chmel H, Buse M: Serum levels of arabinitol in the detection of invasive candidiasis in animals and humans. J Infect Dis 143: 677–683, 1981.PubMedCrossRefGoogle Scholar
  21. 21.
    Armstrong D, Wong B: Central nervous system infections in immunocompromised hosts. Annu Rev Med 33: 293–308, 1982.PubMedCrossRefGoogle Scholar
  22. 22.
    Armstrong D: Central nervous system infections in the compromised host, in Rubin RH, Young LS (eds): Clinical Approach to Infection in the Compromised Host. New York, Plenum Medical, 1981, pp 163–194.Google Scholar
  23. 23.
    Sen P, Louria DB: Higher bacterial and fungal infections, in Grieco MH (ed): Infections in the Abnormal Host. New York, Yorke Medical Books, 1980, pp 326–359.Google Scholar
  24. 24.
    Medoff G, Kobayashi GS: Strategies in the treatment of systemic fungal infections. N Engl J Med 302: 145–155, 1980.PubMedCrossRefGoogle Scholar
  25. 25.
    Kantrowitz PA, Fleischli CJ, Butler WT: Successful treatment of chronic esophageal moniliasis with a viscous suspension of nystatin. Gastroenterology 57: 424–430, 1969.PubMedGoogle Scholar
  26. 26.
    Petersen EA, Alling DW, Kirkpatrick CH: Treatment of chronic mucocutaneous candidiasis with ketoconazole: A controlled clinical trial. Ann Intern Med 93: 791–795, 1980.PubMedGoogle Scholar
  27. 27.
    Graybill JR, Drutz DJ: Ketoconazole: A major innovation for treatment of fungal disease. Ann Intern Med 93: 921–923, 1980.PubMedGoogle Scholar
  28. 28.
    Kirkpatrick CH, Ailing DW: Treatment of chronic oral candidiasis with clotrimazole troches. N Engl J Med 299: 1201–1203, 1978.PubMedCrossRefGoogle Scholar
  29. 29.
    Beggs WH, Sarosi GA: Combined activity of ketoconzaole and 5-fluorocytosine on potentially pathogenic yeasts. Antimicrob Agents Chemother 21: 355–357, 1982.PubMedGoogle Scholar
  30. 30.
    Med Lett 24:36–38, 1982.Google Scholar
  31. 31.
    Bennett JE, Dismukes WE, Duma RJ, et al: A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptococcal meningitis. N Engl J Med 301: 126–131, 1979.PubMedCrossRefGoogle Scholar
  32. 32.
    Bennett JE, Remington JS: Miconazole in cryptococcosis and systemic candidiasis: A word of caution. Ann Intern Med 94: 708–709, 1981.PubMedGoogle Scholar
  33. 33.
    Gottlieb MS, Schroft R, Fligiel S, et al: Gay-related immunodeficiency (GRID) syndrome: Clinical and autopsy observations. Clin Res 30: 349A, 1982.Google Scholar
  34. 34.
    Fainstein V, Bolivar R, Mavligit G, et al: Disseminated infection due to Mycobacterium avium-intracellulare in homosexual men with Kaposi’s sarcoma. J Infect Dis 145: 586, 1982.PubMedCrossRefGoogle Scholar
  35. 35.
    Lester TW: Drug-resistant and atypical mycobacterial disease: Bacteriology and treatment. Arch Intern Med 139: 1399–1401, 1979.PubMedCrossRefGoogle Scholar
  36. 36.
    Davidson PT, Khanijo V, Goble M, et al: Treatment of disease due to Mycobacterium intracellulare. Rev Infect Dis 3: 1052–1059, 1981.PubMedCrossRefGoogle Scholar
  37. 37.
    Corpe RF: Surgical management of pulmonary disease due to Mycobacterium avium-intracellulare. Rev Infect Dis 3: 1064–1067, 1981.PubMedCrossRefGoogle Scholar
  38. 38.
    Drew WL, Mintz L, Miner RC, et al: Prevalence of cytomegalovirus infection in homosexual men. J Infect Dis 143: 188–192, 1981.PubMedCrossRefGoogle Scholar
  39. 39.
    Hirsch MS: Herpes group virus infection in the compromised host, in Rubin RH, Young LS (eds): Clinical Approach to Infection in the Compromised Host. New York, Plenum Medical, 1981, pp 389–415.Google Scholar
  40. 40.
    Wade JC, Newton B, McLaren C, et al: Intravenous acyclovir to treat mucocutaneous herpes simplex virus after marrow transplantation: A double-blind study. Ann Intern Med 96: 265–269, 1982.PubMedGoogle Scholar
  41. 41.
    Straus SE, Smith HA, Brickman C: Acyclovir for chronic mucocutaneous herpes simplex virus infection in immunosuppressed patients. Ann Intern Med 96: 270–277, 1982.PubMedGoogle Scholar
  42. 42.
    Crumpacker CS, Schnipper LE, Marlowe SI, et al: Resistance ot antiviral drugs of herpes simplex virus isolated from a patient treated with acyclovir. N Engl J Med 306: 343–346, 1982.PubMedCrossRefGoogle Scholar
  43. 43.
    Burns WH, Santos GW, Serai R, et al: Isolation and characterization of resistant herpes simplex virus after acyclovir therapy. Lancet 1: 421–423, 1982.PubMedCrossRefGoogle Scholar
  44. 44.
    Ashraf MH, Campalani GC, Qureshi SA, et al: Acyclovir in treatment of cytomegalovirus pneumonia after cardiac transplantation. Lancet 1: 173–174, 1982.PubMedCrossRefGoogle Scholar
  45. 45.
    Cheeseman SH, Rubin RH, Stewart MD, et al: Controlled clinical trial of human leukocyte interferon in renal transplantation. I. Effects of cytomegalovirus and herpes simplex virus infections. N Engl J Med 300: 1345–1349, 1979.PubMedCrossRefGoogle Scholar
  46. 46.
    Merigan TC: Interferon therapy in human viral infections and malignant disease, in: Stiehm ER (moderator): Interferon: Immunobiology and Clinical Significance. Ann Intern Med 96:80–93, 1982, pp 88–90.Google Scholar
  47. 47.
    Jones JF, Jeter WS, Fulginiti VA, et al: Treatments of childhood combined Epstein-Barr virus/ cytomegalovirus infection with oral bovine transfer factor. Lancet 2: 122–124, 1981.PubMedCrossRefGoogle Scholar
  48. 48.
    Ruskin J: Parasitic diseases in the compromised host, in: Rubin RH, Young LS (eds): Clinical Approach to Infection in the Compromised Host. New York, Plenum Medical, 1981, pp 269–334.Google Scholar
  49. 49.
    Hughes WT: Pneumocystis carinii pneumonia. N Engl J Med 297: 1381–1383, 1977.PubMedCrossRefGoogle Scholar
  50. 50.
    Centers for Disease Control: Update on Kaposi’s sarcoma and opportunistic infections in previously healthy persons-United States. MMRW 31: 294, 300–301, 1982.Google Scholar
  51. 51.
    Turbiner EH, Yeh SDJ, Rosen PP, et al: Abnormal gallium scintigraphy in Pneumocystis carinii pneumonia with a normal chest radiograph. Radiology 127: 437–438, 1978.PubMedGoogle Scholar
  52. 52.
    Young LS: Trimethoprim-sulfamethoxazole in the treatment of adults with pneumonia due to Pneumocystis carinii. Rev Infect Dis 4: 608–613, 1982.PubMedCrossRefGoogle Scholar
  53. 53.
    Sattler FR, Remington JS: Intravenous trimethoprim-sulfamethoxazole therapy for Pneumocystis carinii pneumonia. Am J Med 70: 1215–1221, 1981.PubMedCrossRefGoogle Scholar
  54. 54.
    McKenna F, Davison AM, Giles GR: Response of Pneumocystis carinii pneumonia only after high-dose cotrimoxazole. Lancet 1: 174, 1982.PubMedCrossRefGoogle Scholar
  55. 55.
    Lawson DH, Paice BJ: Adverse reactions to trimethoprim-sulfamethoxazole. Rev Infect Dis 4: 429–433, 1982.PubMedCrossRefGoogle Scholar
  56. 56.
    Centers for Disease Control Task Force on Kaposi’s Sarcoma and Opportunistic Infections: Epidemiologic aspects of the current outbreak of Kaposi’s sarcoma and opportunistic infections. N Engl J Med 306: 248–252, 1982.Google Scholar
  57. 57.
    Murphey SA, Josephs AS: Acute pancreatitis associated with pentamidine therapy. Arch Intern Med 141: 56–58, 1981.PubMedCrossRefGoogle Scholar
  58. 58.
    Hughes WT, Kuhn S, Chaudhary S, et al: Successful chemoprophylaxis for Pneumocystis carinii pneumonitis. N Engl J Med 297: 1419–1426, 1977.PubMedCrossRefGoogle Scholar
  59. 59.
    Stemmermann GN, Hayashi T, Glober GA, et al: Cryptosporidiosis: Report of a fatal case complicated by disseminated toxoplasmosis. Am J Med 69: 637–642, 1980.PubMedCrossRefGoogle Scholar
  60. 60.
    Tzipori S, Angus KW, Gray EW, et al: Vomiting and diarrhea associated with cryptosporidial infection. N Engl J Med 303: 818, 1980.PubMedGoogle Scholar
  61. 61.
    Fletcher A, Sims TA, Talbot IC: Cryptosporidial enteritis without general or selective immune deficiency. Br Med J 285: 22–23, 1982.CrossRefGoogle Scholar
  62. 62.
    Ammann AJ, Fudenberg HH: Immunodeficiency diseases, in: Fudenberg HH, Stites DP, Caldwell JL, et al (eds): Basic and Clinical Immunology, ed 2. Los Altos, California, Lange Medical Publications, 1978, pp 391–421.Google Scholar
  63. 63.
    Wara DW, Ammann AJ: Activation of T-cell rosettes in immunodeficient patients by thymosin. Ann NY Acad Sci 249: 310–314, 1975.CrossRefGoogle Scholar
  64. 64.
    Quinti I, Pandolfi F, Fiorilli M, et al: T dependent immunity in aged humans. I. Evaluation of T-cell subpopulation before and after short term administration of a thymic extract. J Gerontol 36: 674–679, 1981.PubMedGoogle Scholar
  65. 65.
    Bistoni F, Marconi P, Frati L, et al: Increase of mouse resistance to Candida albicans infection by thymosin. Infect Immun 36: 609–614, 1982.PubMedGoogle Scholar
  66. 66.
    Kalish SB, Ostrow DG, Phair JP: The spectrum of immunological abnormalities in homosexually active males: Association of laboratory findings with prodromal symptoms of the acquired immunodeficiency syndrome (AIDS) (manuscript in preparation).Google Scholar
  67. 67.
    Wallace JI, Coral FS, Rimm IJ, et al: T-cell ratios in homosexuals. Lancet 1: 908, 1982.PubMedCrossRefGoogle Scholar
  68. 68.
    Centers for Disease Control: A cluster of Kaposi’s sarcoma and Pneumocystis carinii pneumonia among homosexual male residents of Los Angeles and Orange Counties, California. MMWR 31: 305–307, 1982.Google Scholar

Copyright information

© Plenum Publishing Corporation 1983

Authors and Affiliations

  • Steve B. Kalish
    • 1
  • David G. Ostrow
    • 2
    • 3
    • 4
    • 5
  • John P. Phair
    • 1
  1. 1.Department of Medicine, Section of Infectious DiseaseNorthwestern University Medical SchoolChicagoUSA
  2. 2.Biological Psychiatry ProgramLakeside Veterans Administration Medical CenterChicagoUSA
  3. 3.Department of PsychiatryNorthwestern University Medical SchoolChicagoUSA
  4. 4.Department of Community MedicineNorthwestern University Medical SchoolChicagoUSA
  5. 5.Howard Brown Memorial ClinicChicagoUSA

Personalised recommendations